The Effect of Direct Oral Anticoagulant Therapy (DOACs) On Oral Surgical Procedures: A Systematic Review

Purpose : Direct oral anticoagulants (DOACs) were developed to overcome the drawbacks of oral anticoagulants. However, not much has been discussed on the perioperative management of patients on DOACs during oral surgical procedures. Thus, we aim to determine the risk of perioperative and postoperative bleeding during oral surgical procedures in patients on DOACs. Methodology : A detailed literature search was performed to find potentially relevant studies using Cochrane Library, Clinical Key, ClinicalTrials.gov, Google Scholar, Ovid, ScienceDirect, and Scopus. Every article available for free in the English literature for the past 5 years, between 2018 -2022 was searched. Results : A total of 1091 abstracts were selected through search strategy across various search engines. Based on inclusion and exclusion criteria, eight clinical studies using DOACs as anticoagulants or studies comparing patients with and without DOACs under oral surgery procedures were found. The results were inconsistent and varied with few studies recommending DOACs administration with bare minimum reported complications and remaining finding no statistically significant difference between discontinuation or continuation of drugs, especially across basic dental procedures. Conclusion : Within the limitation of the study, it can be concluded that minor oral surgical procedures are safe to perform in patients on DOAC therapy. However, the continuation or discontinuation of DOACs in patients undergoing oral surgical procedures remains controversial and requires further studies to extrapolate the results.